CAJ | 학술논문

目的探讨直径≤3 cm肾结石的最佳微创治疗方法. 方法回顾性分析2008年2月至2011年4月收治≤3 cm的109例117侧肾结石患者的临床资料及治疗方法.其中采用输尿管硬镜和软镜钬激光碎石术64例(67侧),采用经皮肾镜钬激光碎石取石术(PCNL) 45例(50侧).比较分析两种方法治疗结石的手术时间、碎石成功率、血红蛋白下降值、术后住院天数、住院费用和并发症. 结果输尿管镜组患者肾结石直径为(2.5±0.9)cm,PCNL组患者为(2.4±0.7)cm,组间比较差异无统计学意义(P＞0.05).输尿管镜组手术均顺利完成,其中43例术中换用输尿管软镜击碎冲入肾盏的结石,术后发热3例,未出现严重并发症.PCNL组手术均顺利完成,术后发热2例,术中、术后明显出血1例,经选择性肾动脉栓塞治愈.输尿管镜组和PCNL组手术时间分别为(117.0±36.5) min及(90.0±18.3) min,一期结石清除率分别为94％(63/67)及92％ (46/50),组间比较差异无统计学意义(P＞0.05)；血红蛋白分别下降(0.3±0.1) g/L及(20.6±8.1)g/L,住院天数分别为(5.0±2.4)d及(7.0±3.7)d,住院费用分别为(15 477.0±754.3)元及(27 453.0±1763.5)元,组间比较差异均有统计学意义(P＜0.05). 结论对于≤3 cm的肾结石,输尿管镜下碎石与PCNL疗效相近,而输尿管镜下碎石还具有创伤小、住院天数少、治疗费用低及并发症发生率低的优势.
목적 탐토직경≤3 cm신결석적최가미창치료방법. 방법 회고성분석2008년2월지2011년4월수치≤3 cm적109례117측신결석환자적림상자료급치료방법.기중채용수뇨관경경화연경화격광쇄석술64례(67측),채용경피신경화격광쇄석취석술(PCNL) 45례(50측).비교분석량충방법치료결석적수술시간、쇄석성공솔、혈홍단백하강치、술후주원천수、주원비용화병발증. 결과 수뇨관경조환자신결석직경위(2.5±0.9)cm,PCNL조환자위(2.4±0.7)cm,조간비교차이무통계학의의(P＞0.05).수뇨관경조수술균순리완성,기중43례술중환용수뇨관연경격쇄충입신잔적결석,술후발열3례,미출현엄중병발증.PCNL조수술균순리완성,술후발열2례,술중、술후명현출혈1례,경선택성신동맥전새치유.수뇨관경조화PCNL조수술시간분별위(117.0±36.5) min급(90.0±18.3) min,일기결석청제솔분별위94％(63/67)급92％ (46/50),조간비교차이무통계학의의(P＞0.05)；혈홍단백분별하강(0.3±0.1) g/L급(20.6±8.1)g/L,주원천수분별위(5.0±2.4)d급(7.0±3.7)d,주원비용분별위(15 477.0±754.3)원급(27 453.0±1763.5)원,조간비교차이균유통계학의의(P＜0.05). 결론 대우≤3 cm적신결석,수뇨관경하쇄석여PCNL료효상근,이수뇨관경하쇄석환구유창상소、주원천수소、치료비용저급병발증발생솔저적우세.
Objective To compare the therapeutic effect of retrograde ureteroscopic Ho:YAG laser lithotripsy (UHL) and percutaneous nephrolithotripsy (PCNL) in treating patients with renal calculi of ≤3 cm.Methods From Feb.2008 to Apr.2011,a total of 109 cases (117 renal calculi in total) treated by either PCNL (50) or UHL (67) were retrospectively analyzed.Operative time,stone free rate,postoperative hospital stay,hospitalization expenses and complications were compared in the 2 groups.Results The mean stone burden of the UHL group and PCNL group was 2.5 cm (1.5-3.0) cm and 2.4 cm (1.3-3.0) cm,respectively.There was no significant difference in two groups.In UHL group,operations were performed successfully in all 67 calculi,of whom,43 patients needed combination of flexible ureteroscopy to break the stone fragments falling into the renal calices.No serious complication was recorded except postoperative fever in 3 cases.In PCNL group,all patients had been successful operated.Postoperative fever occurred in 2 cases.Obvious intraoperative and postoperative haemorrhage appeared in 1 case,and cured by selective renal artery embolization.The operation time of the UHL group and PCNL group was (117.0±36.5) min and (90.0±18.3) min respectively,and had no significant difference in two groups (P＞0.05).The stone free rate of the UHL group and PCNL group was 94％ (63/67) and 92％ (46/50) respectively,and had no significant difference in two groups (P＞0.05).Hemoglobin decline of the UHL group and PCNL group was (0.3±0.1) g/L and (20.6±8.1) g/L,and had significant difference in two groups (P＜0.05).Postoperative hospital stay of the UHL group and PCNL group was (5.0±2.4) day and (7.0±3.7) day,and had statistical difference in two groups (P＜ 0.05).Hospitalization expenses of the UHL group and PCNL group was (15 477.0±754.3) RMB and (27 453.0± 1763.5) RMB,and had statistical difference in two groups (P＜0.05).Conclusions Although UHL and PCNL have similar curative effect in treating renal stones of less than 3 cm,UHL have the advantages of lcss trauma and complication,lower expenses and fewer hospital stay.In treating renal stones of smaller than 3 cm,especially in the contraindication of PCNL,UHL may be a better choice.